Incidence of dementia in relation to stroke and the apolipoprotein E epsilon4 allele in the very old. Findings from a population-based longitudinal study

BACKGROUND AND PURPOSE: Both stroke and the apolipoprotein E (APOE) epsilon4 allele increase the risk of dementia. However, the interaction between stroke and APOE on dementia is still unclear. We addressed this topic by using a longitudinal design. METHODS: We followed up a community cohort of 1301 subjects aged >/=75 years, who did not have dementia at baseline. Among them, 92 subjects had a history of stroke (from 3 months to 16 years before baseline interview). After the 3-year follow-up, 224 dementia cases had been diagnosed. During the period of follow-up, 91 subjects had a first occurrence of stroke (incident stroke). The APOE genotype was known for 985 subjects. Cox proportional hazards regression models were constructed to estimate the risk for dementia in terms of relative risks (RRs) for stroke and the APOE epsilon4 allele, with adjustment for age, sex, education, systolic blood pressure, antihypertensive medication use, and heart disease. RESULTS: In the entire study population, RRs for dementia related to history of stroke and incident stroke were 1.7 (95% CI, 1.1 to 2.6) and 2.4 (95% CI, 1.6 to 3.5), respectively, after adjustment for all potential confounders. Subjects with stroke that occurred within 3 years before baseline had RR of 2.4 (95% CI, 1.4 to 4.2), whereas those with stroke occurring >3 years before baseline had RR of dementia of 1.1 (95% CI, 0.6 to 2.3). Among those with APOE information, individuals with only history of stroke (that occurred within 3 years before baseline) had RR of 3.1 (95% CI, 1.4 to 6.6), individuals with only the APOE epsilon4 allele had RR of 1.7 (95% CI, 1.1 to 2.5), and individuals with both factors had RR of 5.3 (95% CI, 2.1 to 13.4). The corresponding figures when incident stroke was examined instead of history of stroke were 2.3 (95% CI, 1.3 to 4.1), 1.7 (95% CI, 1.1 to 2.4), and 4.6 (95% CI, 2.0 to 10.6), respectively. The RR of interaction term for history of stroke and APOE epsilon4 was 1.1 (95% CI, 0.3 to 3.8; P=0.8). The corresponding figure was 1.2 (95% CI, 0.4 to 4.4; P=0.7) for incident stroke and APOE epsilon4. Furthermore, the RRs of dementia without any stroke and dementia with stroke in relation to APOE epsilon4 were 1.6 (95% CI, 1.1 to 2.3) and 1.2 (95% CI, 0.6 to 2.4), respectively. In addition, the APOE epsilon4 allele was not significantly related to the occurrence of stroke (RR=0.8; 95% CI, 0.5 to 1.5). CONCLUSIONS: A relatively fresh stroke is a risk factor for dementia. APOE epsilon4 increases the risk of dementia without stroke but not dementia with stroke. Our data do not support a multiplicative effect of stroke and the APOE epsilon4 allele on the risk of dementia. However, both factors seem to have an additive effect on the risk of dementia. The APOE epsilon4 allele does not increase the risk of stroke in this Swedish elderly population.     

Evaluation of combined therapy with chemoembolization and irradiation for large hepatocellular carcinoma

The effects of combined transcatheter arterial chemoembolization (TACE) and radiotherapy in patients with large hepatocellular carcinoma (HCC) were analysed retrospectively. A total of 107 patients with large unresectable HCC was treated with TACE followed by external beam irradiation. The largest dimension of the tumours ranged from 5 cm to 18 cm. Acute effects, survival rates, toxicity and prognostic factors were analysed. Follow-up ranged from 4 months to 98 months (median 24 months). An objective response, i.e. reduction of tumour area greater than 50%, was achieved in 48.6% of cases. In 64.9% of the cases with increased alpha-feto protein (AFP) values, AFP level underwent a reduction of more than 25%. The cumulative survival rates at 1, 3 and 5 years were 59.4%, 28.4% and 15.8%, respectively (median survival 18 months). The combination therapy was generally well tolerated. Only two patients died from liver failure or variceal bleeding associated with therapy. The Cox proportional hazards model showed that the number of tumours and the irradiation dose were independent prognostic factors. The results indicate that combined TACE with radiotherapy is a promising therapeutic approach for large unresectable HCC. Prospective controlled trials to ascertain the real potential benefit of this approach are required.     

反相高效液相色谱法测定塞来昔布片含量

目的 :建立反相高效液相色谱法测定塞来昔布片的含量。方法 :采用ZorbaxSB -C18色谱柱 ,以 0 .0 2mol·L-1磷酸二氢钾缓冲液 (pH5 .8) 乙腈 (4 5 :5 5 )为流动相 ,流速为 1.0mL·min-1,以 5 甲基 2 硝基苯酚为内标物 ,检测波长为 2 5 2nm。结果 :塞来昔布在 10 .2～ 5 0 .1mg·L-1范围内呈良好线性 (r =0 .9998) ,平均回收率为 99.8% ,RSD为 0 .35 %。结论 :本法可用于该片的含量测定 ,操作简便 ,结果准确。     

氢溴酸右美沙芬片健康人体生物等效性

目的 :研究氢溴酸右美沙芬片在健康人体的药动学及相对生物利用度。方法 :8名健康受试者单剂量随机交叉口服氢溴酸右美沙芬片参比制剂和被试制剂 6 0mg ,采用HPLC法测定用药后不同时间的血药浓度。结果 :2种制剂的体内过程均符合一房室开放模型 ,参比制剂和被试制剂的tmax分别为 (2 72± 0 2 1)h和 (2 74± 0 19)h ,cmax分别为 (5 5 1± 0 4 4) μg·L-1和(5 5 8± 0 2 7) μg·L-1,AUC分别为 (4 5 3± 2 9) μg·h·L-1和 (4 5 7± 3 0 ) μg·h·L-1,被试制剂的相对生物利用度为 (10 1±5 9) %。结论 :2种制剂具有生物等效性。     

胎盘早剥32例临床分析

目的 通过对胎盘早剥的临床分析，探讨早期诊断及治疗方法，以降低孕产妇和围产儿死亡率。方法 对我院200l—2002年元月收治的qd胎盘早剥32例进行顾性分析。结果 围产儿死亡19例，死亡率59．3％，其中胎死宫内者17例，新生儿死亡2例。孕产妇32例中1例并发DIC及凝血功能障碍，经及时刨救治愈。无孕产妇死亡。结论 胎盘早剥的早期诊断更应注重病史及诱因，B超已成为胎盘早剥的重要辅助诊断方法。适时终止妊娠可减少母子严重的并发症。     

吸毒对肺结核患者病情的影响

目的　探讨吸毒对肺结核患者病情的影响。 方法　 对比吸毒和非吸毒肺结核患者治疗前后的临床症状、痰菌情况及胸片的改变。 结果　 治疗前吸毒者患肺结核的临床症状重 ,痰菌阳性率、空洞形成率和病变范围与对照组比较均明显升高 ;治疗后肺结核临床症状改善率、痰菌阴转率、胸片病灶吸收好转率及空洞缩小率则明显降低 ,两者比较差异有显著性 (P <0 .0 1)。 结论　吸毒对肺结核病情有加重作用     

急性硬膜下血肿预后因素分析

目的 探讨CT征象、GCS评分、瞳孔变化、手术时机、血压、年龄、血糖、血白细胞计数和并发症对96例急性硬膜下血肿手术患者预后因素的影响。方法 对我科96例急性硬膜下血肿手术患者预后影响因素进行回顾性分析。结果 按COS标准，恢复良好46．9％，中度残疾9．4％，重度残疾6．3％，持续性植物生存5．2％，死亡32．2％。结论 CT征象、GCS评分、瞳孔变化、手术时机、血压、年龄、血糖、血白细胞和并发症是评价急性硬膜下血肿预后的可靠指标。及时、正确清除血肿，标准去骨瓣减压，维持正常血压，控制血糖和防治并发症，能有效改善急性硬膜下血肿患者预后，也是降低患者死残率的最有效措施。     

氨氯地平治疗中老年性高血压临床分析

目的　观察氨氯地平 (Amlodipine)对中老年性高血压患者的血压、心率及肾功能的影响。 方法　分别测量用药前后高血压患者的血压、心率及肾功能具体数值 ,再作统计学分析。 结果　Amlolipine可明显降低高血压患者的血压 (P <0 .0 1) ,而对心率和肾功能的影响不大 (P >0 .0 5 )。 结论　Amlodipine是一种完全有效的降压药。     

天麻素在大鼠体内的药动学研究

 目的研究天麻素在大鼠体内的药动学，探讨其在大鼠体内的动力学特征。方法采用胆管结扎术和颈静脉插管术，同时建立高效液相色谱法测定血浆中天麻素浓度的变化，应用3P87药动学程序对血药浓度数据进行拟合。结果天麻素在25～800 μg·mL^-1浓度范围内样品峰面积与内标峰面积比呈良好线性关系，其相关系数r=0.995。提取平均回收率83.6%，日内、日间RSD＜15%。大鼠静脉注射天麻素后体内药动学符合开放性双隔室模型，而灌胃给药符合开放性单隔室一级吸收模型，其绝对生物利用度为86.1%。大鼠结扎胆管前后AUC_0～180分别为(18±9)，(15±13) mg·min·mL^-1，经方差分析无显著性意义。结论天麻素在大鼠体内不存在肠肝循环。